Hello, I am Dr Ola and I would be happy to address your questions about Niko. In my experience, the formation of lick granulomas usually have many factors at play. Typically, they occur in dogs that are incredibly clever breeds that require a lot of stimulation in their environments and/or "a job", with GSD being at the top of the list! It usually starts out as a little bit of an obsessive compulsive behavior that starts the compulsive, repetitive licking of the the same area. The licking with moisten the skin to the point that it breaks down the skin barrier and allows for bacteria on the skin and in the environment to set up a secondary infection. Once the infection takes place, it is accompanied by an increase in licking behavior both from the compulsive behavior as well as the irritation from the histamine release and ability of the immune system to fight the infection.
If your veterinarian hasn't already done so (and assuming Niko has no underlying conditions or on any medications that would contraindicate this), I recommend the additional of an oral steroid that can be tapered over the course of the antibiotic period length. The steroid will decrease inflammation and "itching" sensation to distract him from licking the area. Most lick granulomas result in chronic skin infection and require more than one antibiotic for resolution at a minimum of 3-4 weeks. I would also request if Niko can be prescribed with a mild anti-anxiety medication for the duration of time that it is healing; both to calm him as well as allow you to keep the area bandaged until it has healed some what.
If you are in an area where you can find a veterinarian that is certified in acupuncture (like myself), a good method to try is placement of the acupuncture needles surrounding the granuloma. This usually involves a few treatment sessions but works to increase blood supply to the area, decrease inflammation and promote natural healing. It can work wonders!
Lick granulomas can be very frustrating to treat but the key and rarely involves one magic remedy. It usually requires the correct oral medications, calming the anxiety component that contributed to its origin as well as giving it time to heal properly so be patient!
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